776-P: SGLT2i Increased the Fasting Glucagon Level in Patients with Diabetes: A Meta-analysis

Sodium-glucose cotransporter 2 (SGLT2) inhibitors block reabsorption of glucose by inhibiting SGLT2 in kidney, promotes the renal excretion of glucose. They have been proven to have a good glucose-lowering effect. To evaluating the effect of SGLT2 inhibitor on fine glycemic variability in type 2 diabetes mellitus (T2D) was used a continuous glucose monitoring system (CGMS) Freestyle Libre. The coefficient of variation (CV) of glucose levels every 15 minutes in the midnight zone (11pm-3am), which is less associated with diet and stress, was measured just before and just after the first administration of the SGLT2 inhibitor. Luseogliflozin (2.5mg per day) was administered to 6 patients with T2D. In Addition, fasting plasma glucose, postprandial plasma glucose, C-peptide, other hormones and metabolites were assessed. Luseogliflozin strongly suppressed CV of glucose (11.6±4.8 to 4.1±2.5, p=0.0012) (Figure). SGLT2 inhibitor suppressed fine glycemic fluctuations. There was no correlation with other factors. This inhibitory effect did not appear with sulfonylurea or DPP-4 inhibitors. (data not shown) Although the result is a new aspect of SGLT2 inhibitor, the clinical significance is not clear. Since Risso A et al reported that glycemic fluctuation cause harm to vascular endothelial cells (AJP 2001), SGLT2 inhibitors may reduce damage of blood vessel via regulation of fine glycemic fluctuation.